The mouth is made up of molars, premolars, canines, and central incisors. Each are shaped differently, have a distinct anatomy and function. The incisors are for cutting, the canines for tearing, the premolars for stability and the molars for chewing. So let’s say we put a crown or resin on an anterior tooth and we leave a high spot. The patient will obviously feel something when he chews, but it won’t be as bad as if it were on a molar. This is basic physics, much as when an angle is used, the further back the high spot in this case, the more they will feel it when chewing.
The high points can be of different caliber, but when you are going to put a resin or even a crown you must take into account that any high spot further back in the posterior part of the mouth will be more of a problem and bother. Any high spots will be greatly magnified when on posterior teeth like molars. Having said that though any high spot in any part of the mouth will be bothersome for the patient. What often happens is that when you place a crown or resin the patient has anesthesia and cannot chew nor feel correctly. They may tell you it feels just fine but the next day will call saying they cannot chew nor eat and may even have pain. That does not mean something is gravely wrong nor that they need a root canal, it is often just a matter of adjustments. This very high point can also be beneficial in the sense that it can help push down other teeth that need it almost like braces. But if it is too high and on top of that the patient tends to bite hard or grind their teeth, then the pain can be intense. Teeth are set on a type of periodontal pad you might say which serves to absorb shock, but again if the bite is too hard and the spot too high, then we have an issue. Keep in mind in an adult we have 150 kilos of pressure per square inch, that’s a lot of pressure to say the least.
It is important to let the patient know ahead of time that they may need to come back to adjust the work done. We check the bite with a special paper and it is normal to have to return for last minute modifications. This is also why I suggest you do not set the crown permanently at first, because when you grind that new crown down to make it fit right, the patient will be able to feel the roughness of that spot with his tongue. This may not matter to some, but others may complain and you will need to take that crown out, have a new one made to size at the lab and pay for all this yourself as a doctor. So better set it temporarily so they can come back and it can even be sent back to the lab if needed. Of course they don’t teach you all this at dental school, there you learn the technical side, but I believe they should teach more about real problems and solutions, the same goes for dental conventions and even in on line forums, instead of talking about who is the best doctor, why not discuss this type of thing? We have all had problems with crowns so I strongly suggest you set them temporarily until the patient is 100 % sure he likes how it feels.
Even after that once in a while a patient may feel discomfort and need a further adjustment, but it would be minor. Keep in mind we are doctors, not Gods. God made the teeth, but man makes replacements at a lab and dentists work with those. Today we have great advanced technology and materials and the dentist does all he can for you but we have our limitations. Also we have to take into account the tongue, cheeks and other things when we work on teeth, so we need to do our best to make that crown fit just right. Dentistry can be stressful because of things like this so let’s do our best to do it right!
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